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Racial/Ethnic Differences in the Relationship Between the Use of Health Care Services and Functional Disability: The Health and Retirement Study (1992–2004)

Correspondence: Address correspondence to Mary Elizabeth Bowen, PhD, Institute of Gerontology, Wayne State University, 87 East Ferry Street, 226 Knapp Building, Detroit, MI 48202. E-mail: mbowen{at}wayne.edu

Purpose: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization. Design and Methods:The study used 12 years of longitudinal data from the Health and Retirement Study (1992–2004), a nationally representative sample of community-dwelling adults older than 50 in 1992 (N = 8,947). Nonlinear multilevel models used self-reported health care service utilization (physician visits and hospital admissions) to predict racial/ethnic differences in disability (activities of daily living and mobility limitations). The models also evaluated the roles of other predisposing (age and gender), health need (medical conditions and self-rated health), and enabling factors (health insurance, education, income, and wealth). Results: Blacks and Latinos utilizing physician visits and hospital admissions were associated with significantly more activity of daily living disability than Whites (p <.001). Blacks utilizing physician visits (p <.001) and hospital admissions (p <.05) and Latinos utilizing hospital admissions (p <.05) were associated with more mobility disability than Whites. Other predisposing, health need, and enabling factors did not account for these racial/ethnic differences. Implications: Nationally, health care use for Blacks and Latinos was associated with more disabilities than for Whites after we accounted for predisposing, health need, and enabling factors. The findings suggest that improving health care quality for all Americans may supersede equal access to health care for reducing ethnic and racial disparities in functional health.

Key Words: Activities of daily living • Mobility • Health disparities • Andersen behavioral model of health services utilization • Multilevel modeling